Conference Coverage

Specialty Pharmacies May Improve DMT Adherence

More than three-fourths of patients using the Vanderbilt Specialty Pharmacy had no out-of-pocket costs for their DMT.


WASHINGTON, DC—Specialty pharmacists may improve access and adherence to therapies for multiple sclerosis (MS), according to research presented at the 2017 National Association of Specialty Pharmacy Annual Meeting. Clinical pharmacies also may reduce patients’ out-of-pocket costs.

The Growth of Specialty Pharmacy

The field of specialty pharmacy has grown during the past several years, particularly through health systems’ development of specialty pharmacies. Previous studies have found that adherence rates to disease modifying therapies (DMTs) among patients with MS range from 56% to 87%. Hanson et al indicated that patients who were enrolled in an integrated specialty pharmacy that included an interdisciplinary team of physicians, pharmacists, and nurses had improved adherence, compared with patients who were not enrolled in such a practice. Greater detail about the effect of specialty pharmacists and specialty pharmacies on patient outcomes, however, has been unavailable.

In 2011, the Vanderbilt Specialty Pharmacy (VSP) at the Vanderbilt University Medical Center (VUMC) in Nashville integrated two full-time clinical pharmacists and two certified pharmacy technicians into approximately 30 specialty clinics, including the VUMC MS Center. The goals of this integrated model were to coordinate care for patients treated with a self-administered DMT, optimize treatment with MS therapies, and reduce relapse rates and disease progression.

A Single-Center Study

Jacob A. Jolly, PharmD, Clinical Pharmacist Supervisor at the VUMC, and colleagues conducted a single-center, retrospective cohort study to describe the role that clinical pharmacists play in the multidisciplinary care of patients with MS and to examine medication adherence rates among patients who received self-administered immunomodulatory therapy from the VSP. Eligible participants had MS and filed at least three prescription claims through the VSP for one or more DMTs between January 2016 and December 2016. DMTs included interferon beta-1a, interferon beta-1b, peginterferon beta-1a, glatiramer acetate, fingolimod, teriflunomide, and dimethyl fumarate.

Jacob A. Jolly, PharmD

The primary end point was medication adherence, as measured by medication possession ratio and proportion of days covered. Secondary end points were the percentage of patients achieving adherence above the benchmark of 80% and the average patient out-of-pocket cost for DMTs.

Participants Had High Adherence and Low Costs

In all, 653 patients were included in the study. The medication possession ratio was 92.9%, and the proportion of days covered was 94.25%. “These averages are higher than [those of] other published reports of adherence to DMTs in patients with MS, even among other specialty care programs,” said the investigators. Approximately 88% of patients achieved a medication possession ratio above 80%, and 89% of patients achieved a proportion of days covered greater than 80%.

The average out-of-pocket cost for patients was $29.78 per fill. Seventy-seven percent of patients had no out-of-pocket costs. “Additional analysis is ongoing to determine whether patient out-of-pocket cost has a positive impact on medication adherence,” said the researchers.

Erica Tricarico

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